Healing Methods Part II

The Germ and Icobasco Approaches to Disease: Comparative Exploration of Zambian/African Traditional and Western Healing Methods among the Tumbuka of Zambia

TABLE 2Rank Order of Ten Diseases Most Frequently Diagnosed or Reported 20025

VILLAGER’S RANK ORDER LIST

CLINIC RANK ORDER LIST

Cilaso (Pneumonia)

Malaria

Mutu (Heachache Chibalubalu)

Respiratory Infection: non-pneumonia

Kaliwondewonde (AIDS)

Respiratory Infection: pneumonia

Chikhoso (Coughing)

Eye Infections

Mnthumbo (Stomachache)

Diarrhea: bloody(suspected dysentery)

Belita (Infant Disease)

Ear/nose/throat infections

Vizilisi (Seizures)

Skin Infections

Longolongo (Infant Disease)

Diarrhea: non-bloody

Pamtima (Diarrhoea)

Trauma: accidents, injuries, wounds, burns

Mchezo (Limping)

Anemia

Table Two and Figure One show what may be ranked as the top ten diseases frequently afflicting the people in the study based on villagers’ perceptions and clinic records. The surprises are that even though the clinic ranked malaria as first, it does not appear among the villagers’ top ten listing. The villagers’ list includes two new infant perhaps pediatric diseases that apparently never existed before even in the 1982 list. While the villagers’ list includes AIDS, the clinic did not even have one official diagnosis or confirmation of AIDS or let alone HIV-AIDS.

Figure Two shows the annual number of clinic diagnoses for the top ten diseases diseases for 1999, 2000, and 2001. Malaria is by far the most prevalent being more than three times the next or second most diagnosed disease: respiratory infection non-pneumonia.

The study determined the types, nature, causes and cures for these illnesses. The results of this study will advance previous research in this area in what is known as the culture-bound syndromes (Schaefer, 2001) which are also alluded to by J. B. Kasolola. According to him, “modern hospitals do not have a cure for some of our indigenous diseases like bakufukizgha, chifusi, and mchezo“6. The study investigated these and many other indigenous diseases and determined their causes and how they are cured. The study investigated how African people simultaneously separate, accommodate and integrate the conflicting aspects of the two epistemologies as they deal with illness and healing.

TUMBUKA PEOPLE

Who are the Tumbuka people? They live in Zambia, a country with a population of 10 million people with 2.02% annual growth rate. It has a life expectancy at birth of 43, and adult literacy rate of 78.2%7. The country is landlocked and shares borders with seven countries; Malawi, Mozambique, Zimbabwe, Namibia, Angola, Congo, and Tanzania. The Tumbuka are one of the many Bantu ethnic groups that are found in Southern Africa. The Tumbuka speak Chitumbuka which is one of 72 bantu languages and dialects that have been recorded in Zambia. They are located in the Eastern Province of the Southern African country of Zambia straddling the border between North-Eastern of Zambia and Northern Malawi. Approximately 750,000 Tumbuka people live in Malawi and 400,000 in Zambia8

Since the early 1920s when the British established and colonized the then Northern Rhodesia, now Zambia, the Tumbuka have maintained their traditional lifestyle, cultural values, and subsistence farming. But their life has also been influence by Western medicine, education, and Christianity. The Tumbuka who live in the Lundazi district of Zambia where the research was conducted, are predominantly subsistence farmers growing maize or corn as the staple food including peanuts, beans, peas, finger millet, sweet potatoes, cassava. The Tumbuka grow and sell cotton cash crops. They use the cash proceeds to pay school uniform and fees, modest clinic fees, and the purchase of modern consumer goods such as bicycles, soap, radios, batteries, sugar, clothing, and traditionally brewed beer. They also raise livestock such as chickens, goats, cattle, and pigs.

The Tumbuka still lead a predominantly traditional life style in which family and close kin reside in small villages surrounded by farm lands divided according to the needs of each family. The Zambian government provides clinics, schools, and agricultural extension services. The Tumbuka have certainly been influenced by modern institutions such as schools and clinics. For example, Nkhanga clinic, Nkhanga Baisc and Boyole Schools were both located in the region where the survey was conducted. These social influences may have created some unique ways of approaching and treating disease. It is within this context that the study was conducted among the Tumbuka of Lundazi district of North-Eastern Zambia.

OBJECTIVES:

This study has three major objectives:

To determine what types of illnesses the Tumbuka describe as exclusively indigenous and only treatable by traditional African/Zambian healing methods and rituals.

To determine what types of illnesses the Tumbuka describe as modern or Western and best treated in the modern clinic or hospital.

To determine what are the perceived causes of the illnesses that are best treated by the ng’anga or traditional healer.

To determine what are the perceived causes of the illnesses that are best treated at the modern clinic and hospital.

It is hoped that data in this research report will constitute a pioneering effort in the area of comparative investigation, assessment, explanation, understanding and documenting indigenous African and Western forms of diagnosis and treatment of illness in Zambia and Africa.

METHODOLOGY:The fieldwork was conducted in the Lundazi District of the Eastern part of Zambia from August 12 to September 14, 2002. The research generated both quantitative and qualitative information. The methods for collecting the data were the survey that used open ended and structured interviews, limited field observation, video images, and still photographs.

The open ended and structured interviews were administered to a sample of 118 respondents; 58 men and 60 women respondents randomly chosen from a sample of 32 villages located among the Tumbuka people in the Northwestern region of the remote Lundazi District in the Eastern Province of Zambia. They responded to an open ended and structured questionnaire that had questions about illness and choices of treatment types and procedures and rituals. The sample of 118 adults responded to questions about HIV-AIDS and the repertoire of diseases and treatments prevalent among the Tumbuka. The questionnaire asked such questions as what are the most common illnesses and how they are treated. What illnesses prompt the use of traditional herbal treatment and use of rituals including consulting a traditional healer? What illnesses are best treated at a modern clinic or hospital? The respondent was asked to identify indigenous forms of herbal treatment and the Western forms of treatment. What are the circumstances in which they choose one or both forms of treatment? Are the two methods ever used together? The respondents were asked about the names of common medicinal plants and what illness they are used to treat. Photographic images of the plants were obtained. Two informants and local assistants were hired to help with the survey. Audio and video tape recorders were used to record detailed descriptions of the indigenous procedures and rituals used in the treatments of illness among the Tumbuka.

The in-depth interviews were conducted with two men and one-woman traditional healers who live in Chief Magodi’s area. The first was at the home of Mr. James Nyirenda, popularly known as “Dr.” J.B Kasolola, who is an African Traditional Healer who lives at Chipeni Village. The second male traditional healer was Nthembo Mphande of Chipewa Village. The female traditional healer who responded to an in-depth interview was Modesto Zimba of Mtema Village. The researcher made limited observations of the traditional healers’ normal routine of receiving, diagnosing, treating and discharging patients. These observations offered the researcher an opportunity to observe the language, interaction, rituals, herbs, diagnosis and the repertoire of treatment for the various diseases.

DATA PRESENTATION and ANALYSIS

The 118 responses to the structured questionnaire were coded and analyzed using (the Statistical Package for the Social Sciences) the SPSS program (George and Mallery, 2003; Babbie, 1999). The open-ended interviews were transcribed and incorporated into the narrative of the report to complement the quantitative information.

How do the Tumbuka treat illness in general?

TABLE ONE

How Do you Treat Illness?

How treat illness

Frequency

Depends on nature of illness

47(39.8%)

Clinic or hospital

40(33.9%)

Ng’anga traditional healer

24(20.3%)

Other

7(5.9%)

Total

118(100.0%)

Table One shows a definite spread between the four options; nearly 40% said the choice depended on the nature of the illness, nearly 34% responded go to the clinic or hospital, 20% to the ng’anga or traditional healer. This may suggest that the Tumbuka may have more options and a much broader appreciation of how illness should be treated. This might indirectly imply that the Tumbuka also may have a multi-causal approach to understanding and treatment of illness.

Do the Tumbuka then believe there are illnesses that are strictly Tumbuka, traditional, or indigenous in their nature?

TABLE TWO

Are there any illnesses that are strictly traditional or Tumbuka?

FREQUENCY

YES

90(76.3%)

NO

28(23.7%)

TOTAL

118(100%)

Table Two shows that 76% of the respondents believed that there are some illnesses that are traditional and nearly 24% said “no”.

TABLE FOUR

Frequency

Ng’anga traditional healer

82(69.5%)

Other

5(4.2%)

Treat self

2(1.7%)

Close relatives

2(1.7%)

Clinic or hospital

2(1.7%)

Total

93(78.8%)

Missing System

25(21.2%)

Total

118(100.0%)

Table Four shows that nearly 70% of the respondents said they consult a ng’anga or traditional healer for the treatment of indigenous diseases. The three tables above create a picture in which the Tumbuka believe there are strictly indigenous illnesses according to 76% of the respondents, atleast 46% believe the source of these types of diseases is being bewitched, and nearly 70% would consult the ng’anga or traditional healer to treat these illnesses.

TABLE FIVE

Are there any illnesses that are strictly modern or new?

Modern illness

Frequency

Yes

111(94.1%)

No

7(5.9%)

Total

118(100.0)

Table Five shows that 94.1% of the sample said “yes” while nearly 6% said no.

TABLE SIX

What are the sources of the Modern Illnesses?

SOURCE MODERN ILLNESS

FREQUENCY

Poor morals

37(31.4%)

Don’t know

36(30.5%)

Other

14(11.9%)

From other countries

12(10.2%)

Poor hygiene

8(6.8%)

Bewitching

5(4.2%)

Evil spirits

1(0.8%)

TOTAL

113(95.8%)

Missing System

5(4.2%)

Total

118(100.0%)

What do the Tumbuka believe are the sources of the modern illness? Table Six shows that 31.4% responded “poor morals”, 30.5% didn’t know, and only nearly 7% said it was poor hygiene.

TABLE SEVEN

How do the Tumbuka treat the modern illnesses?

Modern treatment

Frequency

No cure

47(39.8%)

Clinic or hospital

46(39.0%)

Ng’anga traditional healer

9(7.6%)

Both ng’anga & clinic

7(5.9%)

Treat self

2(1.7%)

Total

111(94.1%)

Missing System

7(5.9%)

Total

118(100.0%)

Table Seven shows that 39% said clinic or hospital, nearly 40% said there was no cure.

The three tables above reflect a picture in which 94.1% of the sample believe there are strictly modern diseases but have limited consensus about their source with 31.4% believing “poor morals” to be the source. Although 39% believe the clinic or hospital can treat these modern illnesses, nearly 40% believe there is no cure for these diseases; which is quiet pessimistic, but accurate view of whether modern medicine can cure some of the emerging new diseases including AIDS. Have the Tumbuka ever heard of the AIDS disease?

TABLE EIGHT

Have you heard of AIDS?

Heard of aids?

Frequency

Yes

117(99.2)

No

1(0.8)

Total

118(100.0%)

Table Eight shows that nearly 100% of the respondents had heard about AIDS.

What did the Tumbuka think was the source of AIDS?

TABLE NINE

What causes AIDS?

Source of AIDS

Frequency

Sex with infected person

83(70.3%)

No one knows

24(20.3%)

Europeans

4(3.4%)

HIV

3(2.5%)

Unknown germs

1(0.8%)

Blood transfusion

1(0.8%)

Others

1(0.8%)

Total

117(99.2%)

Missing System

1(0.8%)

Total

118(100.0%)

Table Nine shows that 70.3% of the respondents said sex with an infected person, 20.5% said no one knew the source of the disease.

Did the respondents know anyone who was currently ill with AIDS,

TABLE TEN

Do you know anyone close to you who is sick with AIDS?

Know Someone ill with AIDS

Frequency

No

62(52.5%)

Yes

56(47.5%)

Total

118(100.0%)

Table Ten shows that 47.5% said “yes” and 52.5% said “no”.

Did the respondents know anyone who has died of AIDS?

TABLE ELEVEN

Do you know someone who has died of AIDS?

Know about aids deaths

Frequency

Yes

105(89.0%)

No

13(11.0%)

Total

118(100.0%)

Table Eleven shows that 89% said “yes” and 11% said “no”.

Did the respondents think AIDS was an old disease?

TABLE TWELVE

Were there any diseases that were like AIDS a long time ago?

Is AIDS an old Disease?

Frequency

No

63(53.4%)

Yes

52(44.1%)

Don’t know

2(1.7%)

Total

117(99.2%)

Missing System

1(0.8%)

Total

118(100.0%)

Table Twelve shows that 44.1% said “yes” and 53.4% said “no”.

The five tables above suggest a very clear status of the knowledge of AIDS among the Tumbuka. The overwhelming number are aware of the epidemic, 70% say its cause as sex with an infected partner, 47.5% know someone who has AIDS, nearly 90% know someone who has died of AIDS, and finally 44% believe AIDS to be an old disease. These findings on AIDS suggest the intense publicity and educational campaigns by the Zambian government and other national and International Non-Governmental Organizations have yielded remarkable results in HIV-AIDS awareness in this remote rural region which is over four hundred miles (600 Kms.) from the country’s capital city of Lusaka.

The expectations were that respondents who said there were illness that were strictly Tumbuka or indigenous would also identify the Ng’anga or traditional healer as the only one who could treat or cure the illnesses. The findings confirm this logical expectation as 98.8% of the 93 respondents who agreed that strictly Tumbuka traditional illnesses existed said they consult the Ng’anga or traditional healer for those types of illnesses.

The expectations were that respondents who said there were strictly modern or new illnesses would also identify the clinic or hospital as the only ones who could treat or cure the illnesses. The findings did not confirm this logical expectation as only 40% of the 109 respondents who agreed that strictly modern illnesses existed said they consult the clinic or hospital for those types of illnesses. Another 43% responded that there was no cure for modern diseases.

DISCUSSION

The initial interpretation of the research findings suggests that the Tumbuka people of Eastern Zambia have a marked or significant dualism in their approach to understanding and treatment of illness. But further exploration suggests that they may have what can be characterized as a multicausal approach to understanding and treatment of disease. Their exposure to the traditional and modern conceptions of the causes of illness which are represented by the Ng’anga or traditional healers and the modern clinic seem to have inspired and solidified complex new approaches to illness that could be termed a unique epistemology.

What these findings suggest is that there is a complex wide range of conception of causes and treatment of disease. There are indigenous or traditional diseases such as mchezo, camdulo,vifusi, and chambo whose nature can be characterized as Icobasco-induced as perhaps an important aspect of a culture-bound syndrome (Schaefer 2001). The interpersonal conflict causes the victim of the traditional disease to incur the wrath of kinfolk through suspected witchcraft, and other forms of harmful magic. In some cases promiscuity, selfishness, social carelessness, and other moral transgressions result in the breaking of sexual and other social taboos that may result into the victim coming down with a particular traditional disease. There are modern diseases like AIDS, yellow fever, certain types of coughing, that are caused by germs or as some respondents said in Tumbuka language: “ndopa kwenda uheni”9 i.e the blood not circulating well in the body. The clinic easily treated these diseases although there was total consensus that AIDS could not be treated by neither the ng’anga nor the clinic.

The research findings suggest that illness among the Tumbuka is never mono-causal the way the Western germ theory might suggest a particular microbe or an injury or defect of a body organ might cause a particular illness. Instead, it seems that for every illness among the Tumbuka there could be at least two or more possible causal factors; the more benign factors that might include germs contracted through poor hygiene, poor circulation of “blood”, or contracting illness in term of contagious diseases like common coughs and colds, and AIDS. The second possible cause is that of the more intractable human cause characterized as Icobasco in this research or what may termed as being “bewitched” for lack of a better term since the latter is always used in a pejorative sense. But there are other causes of illness such as evil spirits from without and the breaking of complex traditional sex, other social taboos, and individual social carelessness or recklessness within the context of the community. The reader should be cautioned against making a sweeping conclusion that when confronted by illness, the Tumbuka at one moment rigidly and rationally decide whether a disease is caused by a germ and therefore could be treated at the Clinic or hospital or alternatively only caused by Icobasco and therefore to be exclusively treated by the Ng’anga or traditional healer. Rather, the etiology, diagnosis, and treatment and understanding of illness is much more fluid, circumstantial, and complex. Predictably, (Table One, nearly 40%) many respondents when asked how illness was treated replied that the “choice depended on the circumstances of the illness” in the broadest sense of the meaning.

The public health campaigns of the Zambian government and other national and international non-Governmental organizations about HIV-AIDS, have been so effective that almost all the respondents, 99.2% of the sample of 118 respondents, had heard about AIDS. On the one hand these statistics are encouraging in the campaign against HIV-AIDS. On the other hand, these responses further complicate the patterns of conception of illness, its sources, and treatment among the Tumbuka. Many of the findings of the study may require further analysis.

CONCLUSION

The sample of rural people who participated in this study confirms that which may have been already apparent over the last several decades. Africans have been living with the Western Germ-chemical perspective promoted by modern clinics and hospitals. They have simultaneously been living with the Icobasco perspective, which is represented by the traditional, indigenous, or ng’anga traditional healer. These may not just be simple choices and options rural Africans have to day for explaining and treating disease. What are characterized as causes and types of disease and options for treatment may suggest and therefore represent a much deeper symbiosis and complex way of looking at disease and healing. To encourage an exclusive monocausal approach to disease and healing may be counterproductive as it would be inconsistent with the circumstances, pracgamatic, and epistemological experiences and worldviews of the rural Africans.

_____5 The survey respondents were asked what diseases they thought were most prevalent in the villages by computing the frequency with which each disease was identified as most prevalent. Mutu (Headache of the chibalubalu type), Kaliwondewonde (AIDS), and Chikhoso (coughing) were all tied at second and so were Pamtima (Diarrhoea) and Mchezo (Limping) tied at ninth. The clinic diagnoses official reports were compiled and they were used to determine the clinic’s rank order list.

6 These are indigenous diseases traditionally believed to be caused by malevolent intentions of individuals or the careless or reckless behavior of significant others, for example, in breaking sexual and other social taboos. For example, “mchezo” also known as “mdulo” is caused by a marriage partner’s adulterous behavior or other indiscretions. The spouse who is the victim will get chronic coughing and chest pains. This will not be cured unless the couple take herbs and perform healing rituals.

Tembo, Mwizenge S., “Traditional Healing Among the Tumbuka People,” an unpublished transcript of an Interview with James Nyirenda or Dr. J. B. Kasolola, a Traditional Healer, Bridgeater: Bridgewater College, 2000.

Tembo, Mwizenge S., “Where Chickens Sleep in Trees: The Importance of Chickens in Rural Zambia,” in The World & I: A Chronicle of Our Changing Era, September 1991.

Tembo, Mwizenge S., “The Witchdoctors are not Wrong: The Future Role and Impact of African Psychology on Individual Well-Being,” Paper Presented at the Annual Meeting of the African Studies Association held in Boston, December 4-7, 1993.

This Research Report was First Presented at the Annual Conference of the Virginia Social Science Association, (VSSA) at Christopher Newport University, VIRGINIA,

March 21-22, 2003

The author obtained his B.A in Sociology and Psychology at University of Zambia in 1976, M.A , Ph. D. at Michigan State University in Sociology in 1987. He was a Lecturer and Research Fellow at the Institute of African Studies of the University of Zambia from 1977 to 1990. During this period he conducted extensive research and field work in rural Zambia particularly in the Eastern and Southern Provinces of the country. He conducted field work for this study during his sabbatical leave in August 2002 in the Eastern Province of Zambia. He has followed the developments in the HIV-AIDS epidemic since the mid 1980s especially as it relates to health policy implications on the African continent. He is co-founder of The Zambia Knowledge Bank (ZANOBA) – organization for Documenting and Validation of Culture and Technology. He is currently Associate Professor of Sociology at Bridgewater College in Virginia.